The Role of Psychotherapy in the Medical Management of Acute Psychiatric Problems

The non-psychiatric physician, generalist, internist and other specialist as well, are in the front line of the professionals who encounter and must treat most emotional problems of the largest number of individuals today. This role promises to become increasingly important in the future as we are feeling the demands for more comprehensive medical mental health care from the hitherto relatively neglected lower socio-economic, underprivileged social groups. Besides, as Braceland¹ has so aptly emphasized, the expansion of Medicine into newer fields of practice — such as transplant surgery, artificial genetic selection, reproductive control and mechanical organ replacement — is already creating new areas for possible emotional disturbance.

Most of these cases are the relatively acute ones, though not necessarily emergencies. Some may be acute exacerbations of chronic conditions. By and large, the primarily chronic psychiatric patient eventually finds his way to the psychiatrist, except perhaps the psychosomatic case who is handled by the non-psychiatrist with attention to his organic status rather than his emotional basis. In this paper we would like to focus on certain dynamic aspects of psychotherapy, applicable to all acute emotional states regardless of their specific diagnosis, about which there seems to be a certain lack of understanding among physicians. These aspects include the significance of the acute symptomatology, the nature of the therapeutic factors, and the goals of treatment.

Let us first ask what is the nature and meaning of such patients’ conditions, in general psychodynamics terms that they seem to demand immediate therapeutic attention and activity. Otherwise stated, how come the physician feels obligated to “treat”, to “do something” when he is confronted with the decision to intervene or not; and how come the patient feels he needs immediate help. We submit that there are many reasons, particularly unconscious ones, for this.

From the physicians’ v